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Urology • Nephrology • Ayurveda

Kidney Stones (Ashmari)

Kidney stones are hard deposits that form when minerals in urine crystallise. Small ones often pass unnoticed; a stone moving down the tube to the bladder causes some of the most severe pain people experience. They are especially common in hot parts of India, where people lose water through sweat. Most stones pass or can be treated easily, and drinking enough water is the single best way to prevent them. Ayurveda describes them as Ashmari.

Go to hospital urgently if

Stone pain with fever or shivering can mean an infected, blocked kidney — a medical emergency that can lead to sepsis. It needs hospital treatment the same day.
  • Pain so severe that painkillers don't help, or vomiting that stops you keeping fluids down
  • You cannot pass urine at all
  • You have only one working kidney, a kidney transplant, or are pregnant

What are kidney stones?

Urine contains dissolved minerals and salts. When urine is concentrated — from too little fluid or heavy sweating — these can form crystals that grow into stones. About 8 in 10 stones are made of calcium oxalate; others are uric acid (linked to gout and high-meat diets), calcium phosphate, or struvite (linked to urine infections). North-western India — Rajasthan, Gujarat, Punjab and neighbouring areas — has particularly high rates, sometimes called the “stone belt”. Once you've had one stone, the chance of another within 10 years is about 50%, which is why prevention matters.

A clear stream flowing over mossy rocks in a forest
Drinking enough water through the day is one of the simplest ways to protect the kidneys and urinary tract.

Symptoms

  • Sudden, severe pain in the back or side, below the ribs, that comes in waves (renal colic)
  • Pain that moves to the lower abdomen and groin as the stone travels down
  • Restlessness — people can't find a comfortable position
  • Nausea and vomiting
  • Blood in the urine (pink, red or brown), which may only show on a test
  • Needing to pass urine often, or burning, as the stone nears the bladder

Will it pass?

The urinary tract and how stone size affects passing Diagram of two kidneys, the ureters and the bladder, with a stone in the ureter. Pain moves from the back to the groin as the stone travels. Stones smaller than 5 millimetres usually pass on their own; 5 to 10 millimetre stones may pass, helped by medicine; stones larger than 10 millimetres usually need a procedure. Kidney Kidney Bladder Stone in the ureter Stone size and passing Under 5 mm Most pass on their own within a few weeks 5–10 mm May pass; medicine can help it through Over 10 mm Usually needs a procedure to break or remove Pain moves from back to groin as the stone travels.
Stone size, position and whether there is infection or blockage decide treatment. The diagram is simplified and not to scale.

Tests & treatment

A urine test, blood tests (kidney function, calcium, uric acid) and imaging — usually a low-dose CT scan or an ultrasound — confirm the stone and its size. Pain is treated with anti-inflammatory painkillers such as diclofenac, if your kidneys and stomach allow. Stones that are passing may be helped with tamsulosin, which relaxes the ureter. Larger or stuck stones are treated with shock-wave lithotripsy (breaking it from outside the body), ureteroscopy with a laser, or PCNL (keyhole surgery) for large kidney stones. If you pass a stone, sieve your urine and keep it — analysing it guides prevention.

Preventing stones

  • Drink enough to pass about 2.5 litres of urine a day — usually 3 litres of fluid or more, and more in summer or with outdoor work. Urine should be pale yellow.
  • Cut down on salt — pickles, papad, namkeen, processed food. Salt increases calcium in urine.
  • Don't cut out calcium. Normal amounts of milk, curd and paneer with meals actually reduce oxalate stones.
  • If your stones are calcium oxalate, moderate high-oxalate foods such as spinach, beetroot, nuts, chocolate and very strong tea.
  • Limit meat, fish and eggs if you have uric acid stones; limit sugary drinks and colas.
  • Lemon juice (nimbu pani without much salt or sugar) and citrus fruits add citrate, which helps prevent stones.
  • Keep a healthy weight; control diabetes and gout. Don't take vitamin C or calcium supplements in high doses without advice.

Ayurvedic view

Increase healthy urine flow (mutrala) → break and expel stones (ashmaribhedana) → reduce the Kapha that binds crystals → prevent recurrence.

Sushruta Samhita counts Ashmari among the eight grave diseases (Ashta Mahagada) and describes four types by dosha and composition, their symptoms — pain at the navel, bladder and perineum, interrupted urine, blood in the urine — and even a surgical operation for bladder stones, one of the oldest recorded. Stones are understood as Kapha binding substances in urine that Vata dries and Pitta hardens. Treatment combines diuretic and stone-breaking herbs, adequate fluids, and diet correction, with surgery for stones that don't respond.

Herbs & safety

  • Pashanabheda (Bergenia ligulata) — literally “stone breaker”
  • Varuna (Crataeva nurvala) and Gokshura (Tribulus terrestris) — diuretic, used for stones and urinary symptoms
  • Kulattha (horse gram) decoction — a traditional remedy for stones
  • Barley water (yava) — a gentle traditional drink to increase urine flow

Small studies suggest some of these may help small stones pass or reduce recurrence, but evidence is limited, and no herb reliably dissolves a large stone. Don't use herbal treatment to delay care when there is fever, blockage, a single kidney or reduced kidney function. Tell your doctor about any herbs you take, and use licensed products.

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Dr. Vikram Desai

Neurology
📍 Bengaluru
Experience: 18 yrs